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Eight lessons from the Nightingale & beyond

In December last year, Dr Dominique Allwood (Director of Improvement and Partnerships, UCLPartners and Associate Medical Director, Imperial College Healthcare NHS Trust) and ImproveWell’s CEO and co-founder, Lara Mott presented at the IHI Forum 2021.  Sharing key learnings both from the NHS Nightingale Hospital London and from ImproveWell’s many partnerships with different healthcare organisations, they looked at what it takes to create a learning system for continuous improvement in care, operations and staff wellbeing. Highlights can be accessed in our latest report – or read here.

  1. There’s no substitute for a rapid feedback loop

While setting up a 500-bed intensive care unit (ICU) hospital in a conference centre in 11 days, the NHS Nightingale Hospital London (the Nightingale) management team adopted a learning system approach to ensure they were improving both continuously and at pace across clinical care, operational delivery and staff experience and wellbeing. Underpinning the learning system were five principles:

  • identify known areas of uncertainty;
  • help the caregiver to help the patient;
  • reduce the burden on frontline clinical staff;
  • learn from every patient; and
  • associate all important practice changes with a rapid feedback loop.

Everything was seen through the lens of continuous improvement and learning fast and acting fast.

2. Sometimes tech is a necessity, not a luxury

When COVID-19 first hit, it was unclear whether the virus was transmissible by touch. This meant access to pens and paper was limited, so ImproveWell’s digital solution gave those on the frontline a voice. By using their own phones, staff could integrate real-time feedback into their daily work quickly and easily.

3. Get fresh perspective

The Nightingale developed a completely new role – the Bedside Learning Coordinator – inspired by military colleagues, to learn from patients and staff and make sure those ideas were implemented swiftly. From the bedside, back to the bedside. This observational conduit was a supplementary role – present to support staff rather than to provide care to patients.

4. Move from ideas to action

From the feedback gathered via staff, patients and the Bedside Learning Coordinators, the quality improvement teams at the Nightingale could then determine what should be fixed (immediate), improved (continuous) and changed (bigger scale).

Getting the data in front of the right decision group – as soon as possible – is crucial. The various data sources should be fed into both large clinical forums and governance meetings right through to the daily huddles on the wards, to ensure the power of the insight is not lost.

At the Nightingale, daily decision-making was fuelled by four simple questions:

  • What have we learnt today?
  • What are we going to do differently tomorrow?
  • What do we still not know?
  • What are we going to do to find out?

Put simply – empower those closest to the problem to decide what and how solutions should be implemented each and every day.

5. Your workforce holds the answers

Giving staff the chance to point out what might seem obvious (such as an amnesty box where people can empty their pockets of unused swabs etc rather than them ending up in the bin at home) as well as the bigger considerations around treatment and respiratory disease means accessing the genius of the hive mind.

What’s more, staff witnessing positive change happening as a result of their own input leads to greater satisfaction at work as well as improved outcomes. And a culture of participatory change means less fear and quicker adoption. Being inclusive at every level of the organisation, and getting the patient’s view too, means that everyone is working in the same direction.

6. There’s no such thing as a bad idea

Every point of view adds to the process, even if it isn’t adopted. Why didn’t it make the grade and what can be learned from that? At ImproveWell we witness countless ideas, large and small from partners across the globe daily. It’s all about stopping the gems slipping through your fingers without adding further burdens to a hard-working workforce.

7. Tell people how to make the change, and always complete the feedback loop

We can only collect people’s ideas, views and sentiment if they know there’s a way to record it. That’s why broad communication via posters, Twitter, flyers, postcards and anything in between is so important to get things off the ground. And when changes are implemented, make sure staff know why it happened (i.e. thanks to them) by labelling the innovation.

Visual presentation is the name of the game – a whiteboard can help to demonstrate the impact of collective feedback, spark conversation about what’s been seen and learnt and make sure data streams are incorporated into everyday learning and action.

8. Never stop improving

There’s always something to fix. Sometimes that can seem a bit overwhelming. Not least during a pandemic. It’s important that those who are being asked to use the app know that it’s not going to be a burden and isn’t just another job to do. ImproveWell’s interface has been designed to make things quick and simple – maximum impact for limited interaction. For those fully wedded to their phones (and digital natives), it’s also a very satisfying app in which to order your thoughts. Win-win.

But technology is not the only answer; low- and no-tech initiatives such as suggestion boxes, pen and paper sentiment trackers, huddles, and rewards and recognition are a great place to start your continuous improvement journey.

Download the eight lessons here

Discover more at

Connect with Dr Dominique Allwood on LinkedIn

Read more about the use of the ImproveWell solution at NHS Nightingale London

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